Hemolytic anemia differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differentiating Hemolytic anemia from other Diseases

Characteristic/Parameter Hemolytic anemia Sideroblastic anemia Anemia of chronic disease Thalassemia Iron-deficiency anemia Erythropoietin deficiency Vitamin B12 deficiency Folate deficiency
Etiology Drug-induced, immune-mediated, non-immune-mediated, infections, rheumatologic disease Bleeding, thrombosis, petechiae, sepsis Renal failure, hematuria, bleeding, microangiopathic hemolytic anemia Renal failure, hematuria, bleeding, microangiopathic hemolytic anemia Petechiae, bleeding, other autoimmune diseases Petechiae, purpura, ecchymoses Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis
Mean corpuscular volume Normocytic (80-100 femtoliter) Low Low Low Low; can be as low as 10000 per microliter Low; can be less than 10000 per microliter; sudden onset after transfusion Variable; usually low Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis
Laboratory abnormalities Indirect hyperbilirubinemia Elevated Normal Normal Normal Normal Usually normal Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis
Physical exam Heparin exposure Sepsis, delivery of fetus, acute promyelocytic leukemia, other malignancy E.coli strain O157:H7; Shiga-like toxin Dysregulation of complement activation; mutation in complement factor H Idiopathic; can be secondary to chronic lymphocytic leukemia, HIV, viral hepatitis, H. pylori Exposure to transfused products Autoimmunity with development of antibodies to DNA Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis
Treatment Yes, always Possible No No Yes No; transfusion-related Possible; drug-induced lupus can be caused by medications like hydralazine or isoniazid Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis
Other associated abnormalities Possible Usually Usually Usually Yes; spontaneous bleeding if platelet count < 10000 per microliter Yes; spontaneous bleeding if platelet count < 10000 per microliter Rare Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis

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